HALT-IT Risk Model: Death due to gastrointestinal bleeding - Evidencio
HALT-IT Risk Model: Death due to gastrointestinal bleeding

The HALT-IT Risk Model is an externally validated prognostic model for 5-day bleed-related mortality among patients with severe upper or lower gastrointestinal bleeding (GIB).

The HALT-IT Risk Model was developed using data from N=11,858 participants (event rate 3.7%) collected by the multicenter, international Haemorrhage ALleviation with Tranexamic Acid - Intestinal System (HALT-IT) trial, and externally validated using data from the 2022 UK Upper GIB (UGIB; N=4,470; event rate 1.7%) and 2015 UK Lower GIB (LGIB; N=2,505; event rate 0.36%) audits.

Research authors: Emma Davies Smith, Gaurav Nigam, Vipul Jairath
Version: 1.8
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Among those with AUGIB, the median (Q1, Q3) risk was 5.8% (3.3, 8.8%) for events and 2.9% (1.5, 5.3%) for non-events.  Predicted risks were lower among those with LGIB: the median (Q1, Q3) risk was 3% (1.4, 4.9%) for events and 1.2% (0.7, 2%) for non-events.

Model discrimination and calibration was good in the development set (optimism-adjusted C-statistic=0.73; calibration intercept=-0.05, slope=0.98), reasonable in the external UGIB cohort (C-statistic=0.77; calibration intercept=0, slope=0.72), but poor in the external LGIB cohort (C-statistic=0.81; calibration intercept=0, slope=0.39).

A risk threshold of 3% (i.e., patient is designated "high risk" if estimated risk >= 3%) is suggested to balance false negatives and accuracy.

Caution is advised when predicting risk among patients with suspected LGIB.

AUGIB: Acute, upper gastrointestinal bleeding

LGIB: Lower gastrointestinal bleeding

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This algorithm is provided for educational, training and information purposes. It must not be used to support medical decision making, or to provide medical or diagnostic services. Read our full disclaimer.

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